Basic Information
| Provider Information | |||||||||
| NPI: | 1275562720 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DAWSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3637 EVERSHOT DR | ||||||||
| Address2: | |||||||||
| City: | MIDLOTHIAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 231124487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4787142970 | ||||||||
| FaxNumber: | 8043786721 | ||||||||
| Practice Location | |||||||||
| Address1: | 9900 W BROAD ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | GLEN ALLEN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 230606512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8043580361 | ||||||||
| FaxNumber: | 8043584286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 02/19/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 043192 | GA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 0101252765 | VA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 000738295K | 05 | GA | MEDICAID |